Cytomegalovirus Infection After CD-34 Selected Autologous Hematopoietic Stem Cell Transplantation for Systemic Sclerosis

Background: Autologous hematopoietic stem cell transplantation (AHSCT) is increasingly used to treat systemic sclerosis (SSc). Data on post-AHSCT infections, including cytomegalovirus (CMV) in this population, are limited. This study aimed to assess risk factors, infection rates, and outcomes of post-transplant CMV infection following CD34-selected AHSCT for SSc. 

Methods: We performed a single-center retrospective study of all AHSCT recipients for SSc complicated by CMV infection. A standardized pre-emptive CMV monitoring approach was employed throughout the study period (antiviral treatment threshold: plasma VL > 450 IU/mL). The primary outcome was the rate of CMV DNAemia or disease. Secondary outcomes included risk factors, management, and treatment outcomes. 

Results: Among 42 AHSCT recipients, 19 (45%) were CMV-seropositive pre-transplant. CMV DNAemia occurred in 10/42 (24%) recipients post-transplant, of which 8/10 (80%) were CMV-seropositive. Median time to CMV DNAemia was 28 days (range: 21–35) post-transplant, with a median peak VL of 665 IU/mL (IQR: 340–1104). There were no cases of CMV disease. CMV seropositivity pre-transplant was a significant predictor of post-transplant CMV DNAemia (relative risk: 4.84, 95% CI: 1.16–20.14; p = 0.026). Of 10 patients with CMV DNAemia, six (60%) received CMV-targeted therapy while four (40%) resolved without treatment. Median duration of CMV targeted therapy was 35 days (IQR: 29–45). One patient (10%) experienced gastrointestinal intolerance necessitating antiviral discontinuation. No patient died or required hospitalization due to CMV infection. 

Conclusions: CMV DNAemia following CD34-selected AHSCT occurred primarily in CMV-seropositive recipients. Though common, CMV DNAemia occurred early post-transplant and was associated with minimal morbidity.